Told her odds were low after two failed IVF attempts, a 42-year-old Gurgaon resident (name withheld) chose to seek another opinion. Under the care of fertility specialist Dr. Nishi Singh Tomar at Prime IVF, she has delivered a healthy baby—a result the clinic attributes to a diagnosis-first approach and a protocol aligned to her biology rather than a recycled template. The patient said she agreed to share anonymised details to reassure others who feel shut out by age.
When she first arrived at the clinic, the impulse was to move quickly into another cycle. Instead, the team paused and reopened the file. Prior stimulation charts, embryology notes from Day 3 and Day 5, transfer timing, luteal support, the cadence of early monitoring—everything was read as evidence rather than history. Age, clinicians say, narrows the margin for error by affecting egg quantity and chromosomal competence; repeating a standard plan often repeats a standard outcome. “We look for the weak link—egg, sperm, embryo development, uterine environment or timing—and we change that link, not just the calendar,” Dr. Tomar said.
The re-evaluation was targeted. Ovarian reserve was reassessed with AMH and antral follicle count, while thyroid, prolactin, vitamin D, and HbA1c were checked to rule out silent disruptors. A high-resolution scan and a diagnostic hysteroscopy were used to ensure the uterine cavity was free of small polyps or adhesions that can compromise implantation yet evade routine imaging. Semen parameters were reviewed; more advanced male-factor testing was kept contingent on history rather than automatic. The picture that emerged suggested that earlier cycles had not fully optimised embryo selection or endometrial timing for a patient in her early forties.
The plan that followed prioritised selection, synchrony, and restraint. Stimulation was individualised to maximise mature oocytes without over-stressing the ovaries. Fertilisation was standardised where clinically indicated using ICSI. Embryos were grown to the blastocyst stage so development, not just appearance, could guide choice. Given the patient’s age, the discussion included chromosomal testing of embryos (PGT-A) as an option to reduce the likelihood of transferring an aneuploid embryo; the decision, the clinic stressed, is case-dependent and not routine for everyone. Transfer was timed to the patient’s endometrial readiness rather than a fixed clinic day, with luteal support adjusted to physiology and early monitoring planned to avoid the familiar churn of anxious visits and unanswered questions.
The result was not dramatic so much as steady. The first β-hCG rose as hoped. At the early scan, a heartbeat flickered. “After so many noes, even a cautious yes felt like sunlight,” the patient said. The pregnancy progressed without major complications. She delivered at term and described the first cry as “a sound I had stopped letting myself imagine.” For her, the difference was as much cultural as clinical: a plan that was explained, choices that were justified, and a team that returned calls before anxiety became panic.
Clinicians caution that outcomes at 40 and beyond vary widely and depend on ovarian reserve, embryo genetics, uterine health, and medical history. Tools such as hysteroscopy, ICSI, blastocyst culture, receptivity-aligned transfer, and, in some cases, PGT-A can improve the probability of success when used for the right indications; they are not guarantees and should not be applied by default. Donor options may be appropriate for some; for others, a refined own-egg strategy remains reasonable. “Fertility science can raise probability; it cannot promise outcomes,” Dr. Tomar said. “Honesty about numbers and clarity about why a step is chosen matter as much as the step itself.”
The clinic did not disclose centre-specific success rates for this case. The patient confirmed that she provided informed consent for anonymised publication. Asked what she would tell others who are hesitating because of age, she said only that a second opinion is not a promise but can be a plan. “I used to walk past the baby aisle quickly,” she said with a laugh. “Now I slow down.”
